Health Topics – Johns Hopkins Medicine Podcasts

The ketogenic diet, which consists mostly of fat with some protein and very few carbs, has gained visibility as other diets such as the paleo diet have become increasingly popular for weight loss, and it’s used to control epilepsy. Is such a diet a reasonable choice for the condition instead of a medication? Mackenzie Cervenka, an expert in the management of adults with epilepsy at Johns Hopkins, offers her opinion.

Cervenka: There may be other circumstances where patients are very hesitant to consider antiseizure drugs or medications in general where it’s a personal preference sort of situation and in which case I would counsel patients that we really don’t have strong evidence to guide us with regard to effectiveness of the diet versus trying an initial antiseizure drug but if that is their personal preference, that is available as a potential therapy.  :26

Cervenka says that any attempt to control epilepsy with diet alone must be carefully monitored, both for recurrent seizures as well as other health parameters such as cholesterol and weight, so seek an expert. At Johns Hopkins, I’m Elizabeth Tracey.

High fat, some protein, very few carbohydrates. That’s largely what constitutes a ketogenic diet, developed 100 years ago to help control epilepsy in children and adults. Now the diet is first line treatment for certain metabolic disorders and is gaining ground for epilepsy management. Mackenzie Cervenka, who specializes in the management of epilepsy in adults at Johns Hopkins, says there is a right time to try the diet.

Cervenka: In my opinion if you’re an adult with epilepsy and you’ve tried at least two antiseizure drugs that are appropriate for your type of epilepsy and continue to have seizures this is a reasonable time to consider the diet. One consideration in addition to that is that if you’re an adult with epilepsy who has a tumor or a lesion or some structural reason for having seizures and there’s an option for having epilepsy surgery, that would be the most appropriate next step to pursue.  :30

Cervenka says support and monitoring are needed when someone tries the diet, so seek expert advice if you’re interested. At Johns Hopkins, I’m Elizabeth Tracey.

In the midst of rising overdose deaths, Spain and a few other countries implemented supervised injection sites so overdoses could be reversed right away, and sure enough, deaths fell. Now the state of Rhode Island has become the first state to approve such a measure. Eric Strain, a substance use disorders expert at Johns Hopkins, comments.

Strain: I fear that our next pivot will be to ‘well, because methadone, buprenorphine and naltrexone aren’t working, we need to offer people safe injection facilities with heroin. And I’m not convinced that that’s the solution. It’s hard for me to see them as making much of an impact. I’m not convinced that they will really help people to move into having purpose and meaning in their lives.   :29

Strain says substance use disorders require an array of interventions to enable people to overcome addiction, and he’s concerned that the supervised injection sites are a stop gap measure. At Johns Hopkins, I’m Elizabeth Tracey.

Opioid overdose deaths reached their highest rate ever in the US in the last 12 months, with a new study showing that expanding prescribing medications like naloxone, doesn’t help. What can stem this tide? Eric Strain, a substance use disorders expert at Johns Hopkins, says those who want to leave their addictions behind must look for the right treatment.

Strain: For the individual who is looking for treatment and wants to move forward I think that the critical thing is to not just say well I’ll take whatever I can find, but to really find some treatment provider or program that will do something more than simply prescribe a medication.  That goes back to the difficulties in finding quality treatment, because we’re not paying for quality treatment.  :28

Strain says until government steps in to mandate what constitutes quality treatment things are not likely to improve. He says it is known what helps keep people in treatment once they start, so implementing that first may be one step in the right direction. At Johns Hopkins, I’m Elizabeth Tracey.

Deaths from drug overdoses topped 92,000 over the previous twelve months, the CDC has reported. Eric Strain, a substance use disorders expert at Johns Hopkins, says the vast majority of those deaths were due to opioids.

Strain: That’s a dramatic increase over 2019 when it was about 51,000. It’s an 18,000 increase in opiate overdoses. Methamphetamine overdoses are increasing. There’s a lot of thought that those seem to be combinations of opioids and stimulants like methamphetamine and cocaine. We can’t fully attribute this to opioids. We need to keep in mind that there’s poly drug use going on and there’s a lot of poly drug use. It’s probably more poly drug use that just a single drug abuse.  :33

Strain says poly drug use can complicate efforts resuscitation efforts because rescuers may not know which agent or combination of agents to use. At Johns Hopkins, I’m Elizabeth Tracey.

Even as Covid deaths begin to climb again nationally, the most recent data on drug overdose deaths shows a dramatic increase in the last year. Eric Strain, a substance use disorders expert at Johns Hopkins, reviews the data.

Strain: The CDC does a rolling number of overdose deaths. They sent out information through December 2020, and there’s a little over 92,000 overdose deaths in the previous 12 months. That’s a 29% increase to the prior year. I think the other thing to be cognizant of is that the overwhelming majority of these are opiate overdoses. Of that 92,000, 69,000, almost 70,000 of them are opioid related. :30

Strain says any number of factors must be considered in understanding this rise, including pandemic related isolation and mental illness, and lack of access to healthcare services including substance use disorder treatment, even while prescribing of medications to help has expanded. At Johns Hopkins, I’m Elizabeth Tracey.

The ketogenic diet is a very high fat and very low carbohydrate diet that helps both children and adults with epilepsy control their seizures, and the diet is now celebrating its one-hundredth anniversary. Eric Kossoff, a neurologist and pediatric ketogenic diet expert at Johns Hopkins, says even then, it was known that such a strategy could help.

Kossoff: The diet was created in 1921 so 100 years ago with the idea being that it was going to mimic periods of starvation and fasting. They knew for decades, you might almost argue for millenia, before 1921, that fasting seemed to help this condition. So when the diet was created that was the intention, was that you would be potentially, okay, that was the idea, mimicking a starvation state. What we know now is that it’s much more complicated than that.  :30

Kossoff says why a high fat diet helps may vary between individuals, and notes that up to 20% of those with epilepsy who try it many not need medication at all. At Johns Hopkins, I’m Elizabeth Tracey.

It’s the 100th anniversary of the so-called ‘ketogenic’ diet, which helps to control epilepsy in children and adults, and can even allow some of them to stop taking medications for the condition. Eric Kossoff, a neurologist and pediatric ketogenic diet expert at Johns Hopkins, describes what such a diet entails.

Kossoff: The diet is a 90+ percent fat diet. And in order to realistically be on a diet like that, most families really do need the guidance of a dietician in terms of measuring and calculating what to eat. Having a gram scale, weighing the foods is how we do the classic ketogenic diet, and there is a version called the modified Atkins diet which we created here at Hopkins, that even with that you’re still measuring carbohydrates per day using a book and keeping track.  :32

Kossoff says if you would like to try the diet, don’t go it alone. Expert advice and monitoring is needed. At Johns Hopkins, I’m Elizabeth Tracey.

The ketogenic diet, which relies on fats and proteins as energy sources and avoids carbohydrates, actually began 100 years ago as a means to control epilepsy in both adults and children and was also used for a host of other conditions. Eric Kossoff, a neurologist at Johns Hopkins and ketogenic diet expert, says after a lull in popularity, the diet is now more popular than ever.

Kossoff: It is no doubt more work than taking a medicine. Not to say all medicines are perfect, they all have side effects but it certainly is less of an imposing situation on a lifestyle to take a medication. The ketogenic diet, which is a high fat, low carbohydrate diet, no matter which version of the diet you do, requires supervision, it requires often a dietician involved, to help with weighing and measuring and calculating. It’s not easy.  :26

Kossoff says depending on which type of epilepsy one has, the ketogenic diet can actually control seizures virtually entirely, and can work in both children and adults. At Johns Hopkins, I’m Elizabeth Tracey.

Among doctors who specialize in cancer treatment, only very few broached the subject of end of life decisions with their patients, even when an analysis of recordings of their encounters pointed toward an opportunity to do so, a recent study found. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, examines the data.

Nelson: The trial had something like 141 patients talking and 31 providers at 2 academic centers. When they looked back at 423 encounters, and found that only 5% or 21 involved formal end of life discussions. They did believe that 38% of the recordings that they listened to provided an opportunity for an end of life discussion that may have been missed.  :24

Nelson says in his own practice he begins a discussion of end of life preferences at the very first visit, before such decisions really must be made. He advises patients to bring up the issue themselves if their physician doesn’t do so, so that their wishes are known. At Johns Hopkins, I’m Elizabeth Tracey.